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How To Control Pain After An Operation?

Back Pain: It Is Possible That The Back Pain Is Due To A “Mechanical” Or Inflammatory Disorder.

How Does Our Team Help?

Financing millions of dollars in research; collaborated with legislators to increase access to medical care; offering local resources.

How Can You Help?

Participate in events to raise awareness about arthritis; lend help as a volunteer; Become a member and donate to support research, programs, and services.

Hispanics And Arthritis

There are approximately 3 million adult Hispanics in the United States with arthritis and millions more with chronic joint pain.

Back Pain: It Is Possible That The Back Pain Is Due To A "Mechanical" Or Inflammatory Disorder

One of the main reasons why people visit the doctor, back pain, can turn daily tasks into a true via Crucis. According to our doctors" for most patients, the problem of pain in the lower back is widespread, but for a small percentage, the pain is the result of spondylitis. They are ankylosing (EA) ". Both can result in pain in the lower back, but they are different diseases.

What Is It?

Type of inflammatory arthritis AS causes pain and stiffness in the lower back that gets worse at night and improves with physical activity. Other portions of the body can also become inflamed. It is more common in males.

Also called mechanical back pain, this broad diagnosis is characterized more by suffering than by stiffness, and movement usually makes it worse. It is estimated that 80% of people suffer from it at some time.

What Is It About?

The vertebrae become inflamed and new bone forms, which causes the spine to merge into a fixed position, sometimes restricting breathing.

It is due to muscular distensions, osteoarthritis, stenosis of the spine (narrowing of the spinal canal), degeneration of the discs due to age and incorrect alignment of the spine.

How is It Diagnosed?

The doctor will review your symptoms and family history. It may be necessary to order blood and imaging tests such as MRI.

The analyzes are done to rule out neurological problems, tumors, infection.

Which Is The Treatment?

Nonsteroidal anti-inflammatory drugs ( NSAIDs ) are prescribed; in more severe cases, inhibitors of tumor necrosis factor (TNF) and physical therapy.

NSAIDs, analgesics aons, and surgical injuries. What remains is the diagnosis of chronic lower back pain. Back pain is best to be seen by a Charlotte Chiropractic clinic, Tebby Chiropractic and Sports Medicine Clinic and corticosteroid injections are recommended; surgery in some instances; complementary treatments such as massage or acupuncture; strengthening exercises.

DOT Physical Near Me in the Charlotte North Carolina Area

DOT Physical Near Me: Navigating Your Next Health Assessment with Ease

A professional conducting a DOT physical examination in a nearby clinic


The phrase “DOT physical near me” is more than a mere search query. It represents a pivotal step for commercial drivers in the United States, emphasizing the importance of health and safety on the road. A Department of Transportation (DOT) physical is a specialized health examination, designed to ensure that drivers are medically qualified to safely operate a commercial vehicle. This article delves into the intricacies of DOT physicals, guiding you through the process of finding, preparing for, and understanding the significance of these critical examinations.

Understanding the Importance of DOT Physicals

Why DOT Physicals are Mandatory for Commercial Drivers

Commercial driving demands high standards of physical and mental fitness. DOT physicals serve as a regulatory measure to ensure that drivers can safely handle the prolonged hours, stress, and physical demands of the job. These physicals assess various health parameters, from vision and hearing to cardiovascular health, catering to the unique challenges of commercial driving.

Key Health Standards in DOT Physicals: What to Expect

A DOT physical evaluates several key health aspects. These include vision tests, hearing tests, blood pressure and pulse rate assessments, and a thorough review of your medical history. Expect examinations related to neurological functions, musculoskeletal condition, and even a urine test for kidney function and possible drug use.

How Often Should You Get a DOT Physical?

DOT physicals are typically valid for up to 24 months. However, if a medical condition requires monitoring, the validity may be shorter. Staying proactive about these timelines is crucial for maintaining your commercial driving license.

Finding a DOT Physical Location Near You

Utilizing Online Resources to Locate Nearby DOT Physicals

In the digital age, finding a “DOT physical near me” is simplified through online directories and resources. Websites like the Federal Motor Carrier Safety Administration (FMCSA) offer locator tools, helping you find certified medical examiners in your area.

Questions to Ask When Choosing a DOT Physical Provider

When selecting a provider, consider asking about their experience with DOT physicals, appointment availability, and what specific tests are included. It’s also wise to inquire about the costs and whether they accept insurance.

What to Bring to Your DOT Physical Appointment

Arrive at your DOT physical with your driver’s license, list of current medications, and glasses or contact lenses if you use them. Also, bring documentation for any existing medical conditions, such as diabetes or heart disease.

Preparing for Your DOT Physical

Tips for a Smooth DOT Physical Experience

Preparation can make your DOT physical more efficient and stress-free. Ensure you’re well-rested, avoid caffeine before the appointment, and have a light meal. Staying hydrated is important, but avoid overconsumption of fluids that could affect your urine test.

Common Reasons for Not Passing a DOT Physical

Common reasons for not passing include uncontrolled hypertension, poor vision or hearing not corrected by aids, and certain cardiovascular issues. Being aware of these can help you prepare better.

Navigating Health Issues and DOT Physicals

If you have ongoing health issues, consult your primary care physician before the DOT physical. They can provide advice on managing conditions like diabetes or hypertension to meet DOT standards.

The DOT Physical Examination Process

What Happens During a DOT Physical Exam?

The exam begins with a review of your medical history, followed by physical examinations like checking your blood pressure, heart rate, lungs, and abdomen. The examiner will also evaluate your vision, hearing, and overall physical ability.

Key Tests and Assessments in a DOT Physical

In addition to the general physical examination, expect specific tests such as a urinalysis for kidney function and substance abuse, a vision test to ensure at least 20/40 acuity, and a hearing test.

Understanding the Medical Examiner’s Certificate

Upon passing the DOT physical, you’ll receive a Medical Examiner’s Certificate. This document is crucial for maintaining your commercial driver’s license and must be renewed before it expires.

After the DOT Physical: Next Steps and Compliance

What to Do If You Pass or Fail Your DOT Physical

If you pass, ensure you keep the Medical Examiner’s Certificate with you while driving. If you fail, follow the examiner’s guidance on addressing the issues and retesting.

Maintaining Compliance with DOT Physical Requirements

Regular monitoring of your health, staying abreast of the expiration date of your physical, and addressing any medical issues promptly are key to maintaining compliance.

The Role of the Employer in DOT Physicals

Employers often play a role in facilitating DOT physicals, sometimes offering resources or guidance on where to get tested.

Common Misconceptions about DOT Physicals

Debunking Myths Surrounding DOT Physicals

One common myth is that passing a DOT physical is extremely difficult. While standards are strict, they are attainable with proper health management.

Understanding the Legalities of DOT Physicals

It’s crucial to understand that DOT physicals are legally mandated for safety reasons, and compliance is not optional for commercial drivers.

Resources and Support for DOT Physicals

Support Groups and Forums for DOT Physical Questions

Online forums and support groups can provide additional insights and shared experiences from other commercial drivers.

Navigating Insurance and Payment for DOT Physicals

Understanding your insurance coverage for DOT physicals can help manage costs. Some employers may also cover the expense.

The Future of DOT Physicals

Advancements in Medical Assessments for Drivers

With technological advancements, future DOT physicals may incorporate more comprehensive and efficient health assessments.

Predicting Changes in DOT Physical Requirements

Staying informed about potential regulatory changes is crucial for continuous compliance.

FAQs about DOT Physicals Near Me

What are the main requirements to pass a DOT physical?
Good vision, hearing, controlled blood pressure, and no serious heart conditions are among the main requirements.

How long is a DOT physical certificate valid?
Typically, it’s valid for up to 24 months, but this can vary based on health conditions.

Can I go to any doctor for a DOT physical?
No, the physical must be conducted by a FMCSA-certified medical examiner.

What are the most common health issues that affect DOT physical results?
Hypertension, diabetes, and heart conditions are common issues.

How can I prepare for a DOT physical to ensure the best outcome?
Manage existing health conditions, get adequate rest, and follow a healthy diet.

Are there any costs involved with a DOT physical?
Yes, costs vary, and it’s important to check if your insurance covers it or if your employer will pay.


Your search for a “DOT physical near me” is a critical step in your journey as a commercial driver. Understanding the process, preparing adequately, and staying informed will help you navigate this requirement smoothly. Remember, a DOT physical is not just about legal compliance; it’s a commitment to your health and the safety of everyone on the road.…

8 Reasons Massage Therapy and Chiropractic Complement Each Other

8 Reasons Massage Therapy and Chiropractic Complement Each Other

Massage therapy and chiropractic care are two distinct therapeutic approaches, yet when combined, they offer a holistic solution to pain, discomfort, and overall wellness. Both therapies focus on the body’s natural ability to heal itself, emphasizing non-invasive treatments that promote optimal health.

Key Takeaways:

  • Massage therapy aids in muscle relaxation.
  • Chiropractic adjustments align the spine.
  • Both therapies offer a comprehensive treatment approach.
  • Combining both can enhance recovery and pain management.

Enhanced Recovery Process

Massage therapy is renowned for its ability to relax tense muscles, improve blood circulation, and promote relaxation. By doing so, it prepares the body for chiropractic adjustments, making them more effective. On the other hand, chiropractic care focuses on the alignment of the spine and the optimal functioning of the nervous system.

Internal Link: How to Treat a Pinched Nerve with Chiropractic Care

Comprehensive Treatment

The combination of massage therapy and chiropractic care offers a holistic approach to health and wellness. While massage addresses muscular issues, chiropractic care targets skeletal problems. Together, they ensure that both the muscular and skeletal systems are in harmony.

YouTube Video: https://www.youtube.com/watch?v=oePaegaM9AE

Internal Link: Chiropractor Charlotte NC – Tebby Clinic

Pain Management

Pain can be debilitating, affecting one’s quality of life. Massage therapy offers immediate relief by targeting pain points and improving blood flow. Chiropractic adjustments, on the other hand, address the root cause of pain, especially if it’s related to spinal misalignments.

Table: Benefits of Pain Management
| Massage Therapy | Chiropractic Care |
| Relaxes tense muscles | Aligns the spine |
| Improves blood circulation | Reduces nerve irritation |
| Promotes relaxation | Addresses root cause of pain |

Internal Link: Tebby Clinic: The Best Chiropractor Charlotte NC Has To Offer

Flexibility and Mobility

Over time, our bodies can become stiff and less flexible. Massage therapy stretches and relaxes muscles, improving flexibility. Chiropractic care, on the other hand, ensures that the joints and spine are functioning correctly, enhancing mobility.

YouTube Video: https://www.youtube.com/watch?v=LrgzAHNa6gQ

Preventive Care

Regular sessions of massage and chiropractic care can act as preventive measures. They can help in identifying and addressing potential issues before they become significant problems. This not only ensures physical well-being but also results in financial savings in the long run, as major treatments can be avoided.

Table: Preventive Care Benefits
| Benefit | Description |
| Early Detection | Identifying issues before they escalate |
| Regular Maintenance | Keeping the body in optimal condition |
| Financial Savings | Avoiding costly treatments in the future |

YouTube Video: https://www.youtube.com/watch?v=v8wEohXtOQM

Mental Well-being

Massage therapy and chiropractic care are not just about physical well-being. They play a crucial role in mental health as well. Massage therapy, in particular, is known for its stress-relieving properties. It helps in releasing endorphins, the body’s natural painkillers, and mood elevators. This not only alleviates pain but also reduces stress and anxiety.

Chiropractic care, on the other hand, ensures that the nervous system functions optimally. A well-functioning nervous system means better mental clarity and focus. Misalignments in the spine can lead to nerve irritations, which can affect brain function. Regular chiropractic adjustments can help in alleviating these issues.

Table: Mental Health Benefits
| Benefit | Description |
| Stress Relief | Massage releases endorphins |
| Mental Clarity | Chiropractic care ensures optimal nervous system function |
| Mood Elevation | Endorphins act as natural mood elevators |

External Link: Chiropractor with Massage Therapist Near Me

Customized Treatment Plans

Every individual is unique, and so are their health issues. Both massage therapists and chiropractors understand this. They offer customized treatment plans based on individual needs. Whether it’s a specific muscle group that needs attention or a particular section of the spine that’s misaligned, these professionals can tailor their treatments accordingly.

Table: Customized Treatment Benefits
| Benefit | Description |
| Individual Assessment | Understanding specific needs |
| Tailored Treatments | Addressing individual health issues |
| Ongoing Monitoring | Adjusting treatments based on progress |

External Link: Best variable speed body massagers

Cost-Effective in the Long Run

While some might argue about the costs associated with regular massage and chiropractic sessions, in the long run, they prove to be cost-effective. Preventive care, early detection of potential issues, and avoiding major treatments can lead to significant savings. Moreover, the combined benefits of both therapies ensure overall well-being, which means fewer visits to doctors and specialists.

Table: Long-term Cost Benefits
| Benefit | Description |
| Preventive Care | Avoiding major treatments |
| Fewer Doctor Visits | Overall well-being reduces the need for specialist visits |
| Long-term Savings | Early detection and treatment can avoid costly procedures |

Enhanced Flexibility and Mobility

Both massage therapy and chiropractic care play pivotal roles in enhancing an individual’s flexibility and mobility. Over time, due to various factors like age, sedentary lifestyle, or injuries, our bodies tend to lose their natural flexibility.

Massage therapy, with its varied techniques, works on muscles, tendons, and ligaments, ensuring they are relaxed and stretched. This not only improves flexibility but also ensures better blood circulation, which aids in faster recovery from muscle soreness.

Chiropractic care, on the other hand, focuses on the skeletal system, especially the spine. Regular adjustments ensure that the spine is aligned, leading to better posture and enhanced mobility. Misalignments can lead to restricted movement, and chiropractic care can effectively address these issues.

Table: Flexibility and Mobility Benefits
| Massage Therapy | Chiropractic Care |
| Muscle relaxation | Spinal alignment |
| Improved blood circulation | Enhanced posture |
| Reduced muscle soreness | Improved joint mobility |

External Link: Understanding the Benefits of Chiropractic Care

Holistic Approach to Health

One of the primary reasons massage therapy and chiropractic care complement each other is their holistic approach to health. Instead of focusing on symptom relief, both these therapies aim at addressing the root cause of the problem.

For instance, chronic back pain could be due to tight hamstrings. While massage therapy can relax these muscles, chiropractic care can address any spinal misalignments that might be contributing to the pain. Thus, by addressing both muscular and skeletal issues, one can achieve long-lasting relief.

Table: Holistic Health Benefits
| Benefit | Description |
| Addresses root cause | Not just symptom relief |
| Comprehensive care | Both muscular and skeletal issues addressed |
| Long-lasting relief | Reduced dependency on pain medications |

YouTube Video: https://www.youtube.com/watch?v=video5

Mental Well-being and Stress Relief

The benefits of massage therapy and chiropractic care aren’t limited to just physical well-being; they extend to mental health as well. In today’s fast-paced world, stress is a common ailment affecting many. Chronic stress can lead to a host of health issues, including headaches, insomnia, and even digestive problems.

Massage therapy, with its soothing techniques, can significantly reduce stress levels. The act of massaging relaxes tense muscles, lowers cortisol levels, and increases the production of endorphins, the body’s natural stress relievers.

On the other hand, chiropractic care, by ensuring the proper alignment of the spine, ensures the optimal functioning of the nervous system. A misaligned spine can lead to nerve irritations, which can manifest as stress, anxiety, and even depression. Regular chiropractic adjustments can help in alleviating these symptoms.

Table: Mental Health Benefits
| Massage Therapy | Chiropractic Care |
| Reduces cortisol levels | Ensures optimal nervous system function |
| Increases endorphin production | Reduces nerve irritations |
| Relaxes tense muscles | Alleviates symptoms of stress and anxiety |

External Link: The Psychological Benefits of Massage Therapy

Prevention is Better Than Cure

One of the standout benefits of combining massage therapy and chiropractic care is the emphasis on preventive care. Instead of waiting for ailments to manifest and then seeking treatment, these therapies focus on ensuring that the body remains in its optimal state, preventing potential health issues.

For instance, regular massage sessions can ensure that muscles remain relaxed and blood circulation is optimal, preventing issues like muscle soreness or even injuries. Chiropractic care, with its focus on spinal health, ensures that potential issues like misalignments are addressed promptly, preventing more severe problems in the future.

Table: Preventive Care Benefits
| Benefit | Description |
| Early detection of issues | Addressing problems before they escalate |
| Regular health checkups | Ensuring the body remains in its optimal state |
| Cost-effective in the long run | Preventing major treatments and their associated costs |

YouTube Video: https://www.youtube.com/watch?v=video6

Customized Treatment for Individual Needs

Every individual is unique, and so are their health requirements. Both massage therapists and chiropractors recognize this fact. They don’t offer a one-size-fits-all solution but instead provide treatments tailored to individual needs.

For instance, an athlete might require a deep tissue massage to address muscle soreness, while someone with chronic back pain might benefit from a combination of Swedish massage and spinal adjustments. The key is to understand the individual’s health status, requirements, and then devise a treatment plan accordingly.

Table: Customized Treatment Benefits
| Massage Therapy | Chiropractic Care |
| Addresses specific muscle groups | Focuses on particular spinal sections |
| Various techniques for different needs | Adjustments tailored to individual requirements |
| Ongoing assessment to modify treatments | Continuous monitoring to adjust care |

External Link: Personalized Chiropractic Care: Why It Matters

Cost-Effective Healthcare in the Long Run

While there might be costs associated with regular massage and chiropractic sessions, in the long run, they prove to be cost-effective. Think of them as an investment in your health. By focusing on preventive care and addressing issues before they become severe, you can avoid costly treatments and medications in the future.

Moreover, the combined benefits of both therapies ensure overall well-being, which means fewer sick days, more productivity, and an enhanced quality of life.

Table: Long-term Financial Benefits
| Benefit | Description |
| Avoiding major treatments | Significant savings in the long run |
| Fewer medications | Reduced dependency on drugs |
| Enhanced quality of life | Priceless! |

YouTube Video: https://www.youtube.com/watch?v=video7

Frequently Asked Questions (FAQs)

1. How often should one combine massage therapy with chiropractic care?
While the frequency can vary based on individual needs, many experts recommend a monthly session for maintenance. However, those with specific health issues might require more frequent sessions.

2. Are there any side effects of combining both therapies?
Both massage therapy and chiropractic care are non-invasive and generally considered safe. However, it’s essential to consult with trained professionals and inform them of any existing health conditions.

3. Is it expensive to get both treatments?
While there might be upfront costs, in the long run, combining both therapies can be cost-effective, especially when considering the benefits of preventive care and overall well-being.

4. Can I get a massage and chiropractic adjustment on the same day?
Yes, many individuals opt for a massage session followed by a chiropractic adjustment on the same day. This can enhance the effectiveness of the adjustment.…

The Weather Can Affect Your Pain

It is not your imagination; the weather can cloud your health. Here we show you what the investigation reveals regarding this connection.


Changes in temperature or barometric pressure, as measured by the weight of circulating air, trigger pain in the joints, although researchers are still not entirely sure why. The higher barometric pressure was also a pain trigger in the Tufts study.

Studies in cadavers have shown that barometric pressure affects the pressure within the joint cavity. In one experiment, when the hip collective pressure was equalized, the joint dislocated about a third of an inch from the normal position.

This may also apply to issues regarding carpal tunnel syndrome.

For more information about the environmental aspects that affect our health, we invite you to visit the Forums and Resources listed in the section Your Body.


The conventional concept that storms wash pollen, smoke, mold and environmental pollutants from the air, making it easier to breathe, may be wrong, according to scientists at the University of Georgia in Athens and Emory in Atlanta. Experts have examined the records of 41 hospitals around Atlanta, finding that emergency visits for asthma increase the day after a storm. The relationship becomes more evident during storms with gusts of moderate to strong winds and humidity.

Although they are unsure of the reason why asthma flares up after a storm, researchers believe that the rain blows pollen grains, resulting in particles smaller and more comfortable to inhale. Likewise, lightning in the atmosphere can unleash a chemical reaction, turning pollutants into asthma promoters.


Studies show that 50 to 80% of all migraine sufferers believe that weather can cause a headache. However, the exact environmental patterns that precipitate migraines remain a mystery.

In a study published in 2004, Dr. Patricia Prince of Children’s Hospital Boston asked 77 individuals with a migraine to document their headaches on the calendar for a space of two years. Then he compared them with the records maintained by the National Meteorological Service.

Nearly half of the study participants had migraines that coincided with weather changes, but not all those who were time sensitive reacted to the same triggers. Some showed greater vulnerability to a combination of high heat and humidity, while others had headaches under precisely the opposite conditions.…

How To Control Pain After An Operation

Eliminating pain in 100% of cases after an operation is difficult, almost impossible. However, following some rules on the use of analgesics depending on the intervention and the patient can achieve better management of the discomfort after passing through the operating room. A study published in 'The Lancet' offers the essential keys to control this type of pain.

There are many kinds of pain, such as that caused by a chronic illness, cancer or a mental disorder. This type of sensations is complicated to treat and often require an individualized follow-up by a team specialized in the treatment of pain. However, the discomfort that originates after a surgical intervention is usually different: acute and specific, frequently related to the fact of the operation and the anxiety generated around this process.

Paul Myles and Ian Power of the Department of Anesthetic and Preoperative Medicine at Alfred Hospital and Monash University, both in Melbourne (Australia), have reviewed the most appropriate therapies to alleviate postoperative pain. The work indicates when to use an analgesic orally or intravenously when to discard one type of drugs and employ others and what kind of processes respond better to one therapy or another.

In the first place, these experts recommend that after an operation the most immediate thing is to measure the pain through a visual or verbal scale established for these patients. In addition to being useful to identify the needs of the patient, the evaluation of the degree of pain could serve to assess the appearance of complications such as bleeding, infection or paralytic ileus.

Small Interventions

The next step is to determine if the operated person continues fasting for a few hours or can take something by mouth after the invasion. If so, it is preferable to opt for opioids in tablets instead of injectables. The dosage of these drugs should be prescribed individually because the needs between each person vary greatly. Also, we must bear in mind that patients over 60 years of age need a 20% lower amount per decade of age.

The paracetamol is the ideal drug for persons subject to a lower or intermediate intervention, which can be performed on an outpatient or require many days of hospitalization. This can be joined any other non-steroidal anti-inflammatory (or a COX-2 inhibitor) and also add tramadol for significant pain.

According to these experts, you can use 1-1.5 g of paracetamol (intravenous, oral or rectal) four times a day. The maximum recommended dose is 5 gr per day for less than five days. Regarding non-steroidal anti-inflammatory drugs (NSAIDs), the article explains that the main drawback of these drugs is their side effects, especially in the elderly. On the one hand, the increased risk of bleeding of NSAIDs and the greater tendency of COX-2 of thrombotic complications makes these specialists decide on naproxen as a complementary therapy to paracetamol in high-risk patients.

Regarding the dose, they recommend 250 mg orally three times a day for naproxen, and 50 mg orally or rectally twice daily for diclofenac. These doses should be reduced to a period of fewer than five days if there is dehydration, renal failure or if the patient is elderly.

For its part, tramadol offers effective analgesia in people undergoing minor or intermediate intervention. It can be used as a complementary therapy to paracetamol taking into account that it is contraindicated in advanced kidney failure, epilepsy, carcinoid syndrome (symptoms that are usually observed in people with carcinoid tumors: in the small intestine, the bronchi ...) and in pheochromocytoma (a tumor of the adrenal gland). The optimal amount will be 100 to 150 mg orally four times a day.

Finally, and as another mutual option in a minor intervention, one can resort to oxyco done, a type of opiate, in doses of 5 to 10 mg every four hours.

Major Surgery

As for the advice for those patients subjected to more complex interventions, these experts recommend the use of the above drugs along with morphine.

“Opioids are effective analgesics in the postoperative period and are the main drugs for medium or strong pain […] Intravenous analgesia is now the standard method for these patients. This technique improves pain control compared to intermittent administration of opiates, “say the authors of this report.

The steps advised by these experts are the intraoperative administration of morphine and the addition of 1-2 mg in the recovery room to control pain before moving the patient to the plant. If a local anesthetic block has been made, the dose of morphine will be lower.

If an anesthetist can control the patient in the plant, the amount of morphine can be 2 mg in an intravenous bolus. But if this specialist cannot be present, the use of 0.10 mg per kilo of weight is recommended intramuscularly or subcutaneously every 2 hours as needed.

If the intensity of the pain is surprisingly high and does not yield with analgesics, the surgical team should be notified to assess the patient.

Analgesia (intravenous, intramuscular or subcutaneous) will be maintained 24 to 72 hours after the intervention to subsequently undergo oral treatment, similar to that of minor operations.

The most important side effects of opioids are depression of the respiratory system, sedation, nausea, vomiting and the inhibition of gastrointestinal motility. For this reason, it is necessary to monitor and monitor these patients to avoid excessive sedation and the appearance of these alterations.